![]() ![]() As such, it is found in pathological (left ventricular failure) as well as physiological (athletic heart, pregnancy) states.Ī fourth heart sound may be heard just before the first sound. It is thought to be due to rapid, high-volume filling of the left ventricle. Wide fixed splitting of the second heart sound occurs in atrial septal defect.Ī third heart sound may be heard soon after the second heart sound. Reverse splitting of the second heart sound can occur in conditions where aortic valve closure is delayed, such as left bundle branch block or paced right ventricle, or where pulmonary valve closure occurs early, such as in the B form of Wolff–Parkinson–White syndrome. This delays right ventricular emptying and pulmonary valve closure, at the same time that pooling of blood in the pulmonary capillary bed hastens left ventricular emptying and aortic valve closure. It is caused by increased venous return and negative intrathoracic pressure. It occurs in inspiration and is more common in the young. Physiological splitting of the second heart sound is when the sound of aortic valve closure (A2) occurs earlier than that of pulmonary valve closure (P2). A2: aortic component of second heart sound EC: ejection click MSC: mid systolic click OS: opening snap P2: pulmonary component of second heart sound (more.) Relative positions of heart sounds and added sounds in auscultation.
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